NIHSS Language and Aphasia 5

Question 1

A patient with stroke has 'word salad' speech — fluent but completely incoherent — and fails to follow any commands. What NIHSS Item 9 score applies?

Accepted Answer

2 — severe aphasia

Answer

Severe aphasia with no useful communication despite fluent jargon output scores 2; score 3 is reserved for mute patients or those with global comprehension loss.

Question 2

Which artery, when occluded, classically causes Wernicke's aphasia by damaging the posterior superior temporal gyrus?

Accepted Answer

Posterior branch of the left MCA

Answer

Wernicke's area (posterior superior temporal gyrus, Brodmann area 22) is supplied by the posterior division of the left middle cerebral artery.

Question 3

When the NIHSS examiner reads a sentence and asks the patient to repeat it, which specific language function is being primarily tested?

Accepted Answer

Auditory processing and verbal output pathway integrity

Answer

Repetition tasks test the perisylvian language network, including auditory input (Wernicke's), the arcuate fasciculus, and verbal output (Broca's).

Question 4

A bilingual patient who speaks English and Spanish suffers a stroke. During the NIHSS, she cannot speak English but family reports she occasionally speaks Spanish. How should Item 9 be scored?

Accepted Answer

Score based on the best language performance observed in either language

Answer

NIHSS instructions indicate the examiner should score the best performance the patient can achieve, including in a second language or using an interpreter.

Question 5

Which finding on NIHSS language assessment most strongly suggests Broca's aphasia rather than global aphasia?

Accepted Answer

Preserved ability to follow simple commands

Answer

In Broca's aphasia, auditory comprehension is relatively preserved, so patients can follow simple commands despite severely non-fluent speech output.

NIHSS - National Institutes of Health Stroke Scale Practice Test

NIHSS - National Institutes of Health Stroke Scale Practice Test

NIHSS Language and Aphasia 5